Dilation and Curettage Preparation

Depending on the type of anesthesia used, the doctor's instructions before a D&C will most likely include the following: Avoid unnecessary drugs: A few days before your D&C, stop taking drugs such as aspirin, which can cause increased risk of bleeding, and any over-the-counter medications, such as cold medication and laxatives. Avoid alcohol and tobacco use. Many surgeons now recommend the patient stop taking any herbal supplements at least two weeks before surgery. Talk with the doctor about all medications you take. Chronic conditions: The doctor will most likely want the patient's other medical problems stabilized prior to the surgery. For example, if the patient has uncontrolled high blood pressure, she may be put on a strict treatment plan in or out of the hospital to improve blood pressure. This is important to avoid any unnecessary complications during the D&C procedure. Eating and drinking: The doctor will also instruct the patient not to eat or drink for 12 hours before your D&C if it is done under general anesthesia (the patient is completely asleep), or for 8 hours before a local or regional (for example, spinal anesthesia, just the lower portion of your body is numbed and you have no feeling) is used. Preliminary tests: On the day before or day of the procedure, the doctor may want to obtain certain routine blood, urine, and other tests to be sure no medical problems have been missed. Naproxen or ibuprofen is usually given for relief from cramping. Narcotics are seldom, if ever, needed for the pain following the D&C.

Nursing management PREOPERATIVE CARE If ordered, ask the woman to come in 24 hours before surgery for insertion of a laminaria tent. This device absorbs cervical secretions and slowly dilates the cervix. Ensure that the woman remains NPO after midnight on the day of surgery. POSTOPERATIVE CARE Monitor circulation and sensation in the legs, and avoid compression of the popliteal area. The lithotomy position requires the womans legs to be elevated in stirrups, which can impair circulation. Instruct the woman to use perineal pads and avoid tampons for 2 weeks. This reduces the risk of infection and allows tissues to heal. Explain that the onset of the next menstrual period may be delayed. Explain that intercourse should be avoided until after the postoperative checkup and after vaginal discharge has ceased. This precaution reduces the risk of infection. Instruct the woman to rest for several days after surgery, avoid heavy lifting, and report any bleeding that is bright red or exceeds that of a normal menstrual period. Vigorous activity, lifting, or straining interferes with healing and may cause hemorrhage.

D and C steps Dilation (the first step): While grasping the cervix with a clamp, the doctor will pass a thin, flexible piece of metal called a sound to determine the depth and angle of the uterus. These measurements allow the doctor to know how far into the uterus the curette can be safely inserted. The usual method of dilation is to insert a thin, smooth metal rod gently along the vaginal canal and up into the tiny cervical opening. The rod is left in place for a moment, then withdrawn and replaced by a slightly larger rod. This process is repeated until the cervix has expanded to about the width of a finger. This method takes about 10 minutes. If the patient is under local anesthesia, she may experience crampy discomfort caused by stretching of the cervical muscles to accommodate the rods. Another method being used with increasing frequency is to insert laminaria tents (cigarette-shaped pieces of a special dried seaweed) into the cervix 8-20 hours before the procedure. The laminaria absorb water from the tissues and swell up, slowly distending and dilating the cervical canal. This is less traumatic than using the metal dilators. Hysteroscopy and curettage (the second step): After dilation, the doctor holds the vagina open again with the speculum. The doctor may also reach into the cervix with a tiny spoon to obtain a specimen of the cervical lining. At this point, the hysteroscope is usually inserted into the uterus so that the doctor may look at the inside of the uterus. The doctor may see fibroids, polyps, or overgrowths of the endometrium. At that time, instruments may be inserted through the hysteroscope and biopsy, or removal, of the fibroids, polyps, or endometrial overgrowths may be accomplished. The doctor will now place a slightly longer and larger curette through the dilated cervix and up into the uterus. This is a metal loop on the end of a long, thin handle. With steady, gentle strokes, the doctor will scrape or suction the uterine wall. This tissue is sent to the lab for analysis. When the curettage is completed, the instruments are removed. If under local anesthesia, the patient will probably experience a tugging sensation deep in the abdomen as the curetting is performed. If this is too painful, the patient should tell the doctor, who may then order pain medicine. The entire procedure, including curettage takes about 20 minutes. At the end, the patient may have cramps that may last about 30 minutes; however, some women experience cramps for a much longer period of time.